36-140 (7) 256 BROOKSIDE CIR BP-2017-0253
GIS#: COMMONWEALTH OF MASSACHUSETTS
„Map:Block:36- 140 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MOL c.142A)
Category:w oodstoye BUILDING PERMIT
Permit# BP-2017-0253
Project# JS-2017-000434
Est. Cost:
Fee:540.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Grow: Homeowner as Contractor_
Lot Size(sq. ft.): 15071.76 Owner: EARLE AMY L Sc ROBERT T
tan_ em: Applicant: EARLE AMY L & ROBERT T
AT: 256 BROOKSIDE CR
Applicant Address: Phone: Insurance:
256 BROOKSIDE CIR (413')313-7435 {1
FLORENCEMA01062 ISSUED ON:873012016 0:00:00
TO PERFORM THE FOLLOWING WORK:PELLET STOVE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of numbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: OH: insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Sionatnre:
FeeType: Date Paid: Amount:
Building 8730(20160:00:00 540.00
212 Main Street, Phone(413)587-1240,Fax:(413) 587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS a.
ttY'vl � .
212 Main Street • Municipal Building 14,
\ Northampton, !W 01060 `
Sig? `J`
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD,COAL,PELLET,CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
Check# 3 3'
Please fill in all appropriate information
L Name of Applicant: I33'pfa cnK a F.R'FIz
J
Address: , -S ;)
(a2 ,, ojixcr ( I fC It Telephone: LI 13 A-)? h'IS5
2. Owner of Property : SgmA
Address: 1 z Telephone'.
3. Status of Applicant: ` Owner Contractor
4. Type or Brand of Stove : pe\\ti k I
5. Estimated Cost: I,SOO
If applicant is not the homeowner::
Contractor name
Construction Supervisor's License Number Expiration Date
Home Improvement Contractor Registration Number Expiration Date
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
6. Certification: I hearby certify that the information contained herein is true and accurate to the best of my
knowledge.
DATE: APPLICANT'S SIGNATURE
p ✓j
/DATE: 0 . 3 0HOMEOWNER'S SIGNATURE 0�c(ILA
APPROVED
DATE: BUILDING OFFICIAL